Sexual Risk-Taking Behaviors Among Adolescents with Severe Emotional Disturbance

We investigated the sexual risk-taking behaviors of adolescents with severe emotional disturbance (SED). Subjects (N = 70) were clients of the South Carolina Continuum of Care. Information on sexual intercourse, sexual risk-taking, aggressive behaviors, substance use, and suicidal behavior was gathered using a modified version of the US Centers for Disease Control and Prevention self-report Youth Risk Behavior Survey. Forty-two percent of each race-gender group reported first intercourse before age 13, except for African American females at 63%. Seventy-five to 79% of all race-gender groups reported first sexual intercourse by age 18. Drinking alcohol before age 13 and carrying a weapon in the past 30 days were associated with first intercourse before age 13. Youth reporting first intercourse between ages 13 and 18 were about 12 times more likely to report suicide ideation than those youth who reported never having sexual intercourse. Youth with SED reporting first intercourse before age 13 appear to have an increased risk for unintended pregnancy and for contracting a sexually transmitted disease compared to youth with SED reporting first intercourse after age 13.     

Insurance Coverage and Mental Health Service Use by Adolescents with Serious Emotional Disturbance

This paper examines the relationships between insurance coverage, need, and mental health services in a community-based sample of 1,015 youths who were 9, 11, and 13 years old at the beginning of the study. They were followed over a two-year period. A strong measure of need based on a standardized diagnostic interview was available and repeated over three annual waves. Data on service use was collected quarterly across two years. Major findings included: (a) high need (serious emotional disturbance [SED]) was strongly related to use of any mental health services; (b) services use was much more likely to occur with public (Medicaid) insurance coverage than either private or no insurance; (c) considerable unmet need was observed even for youths with SED; (d) school-based mental health services potentially substituted for professional mental health services; and (e) there was little unnecessary use of mental health services in the low need group. The major policy implication of these findings is that the regulation of insurance benefits should be based on level of need, rather than on arbitrary limits which are likely to either reduce the probability of or appropriate amount of care for youths who most need mental health services.     

Utilization of Individual versus Family Therapy Among Adolescents with Severe Emotional Disturbance

Service utilization patterns among children with severe emotional and/or behavioral disturbances are described for 89 children and families, interviewed at two time points across a 6-month period. Children received a greater number of individual therapy sessions than family therapy sessions, and children significantly decreased their levels of internalizing and externalizing behaviors. Family therapy was associated with decreases in internalizing behaviors when children reported outcomes. Individual therapy was not associated with changes in either internalizing or externalizing behaviors regardless of reporter. Symptom severity did not dictate whether children were provided individual or family therapy. Recommendations for individualized treatment plans are offered.     

State Hospital Reentry Among Youth with Serious Emotional Disturbance: A Longitudinal Analysis

We investigated the demographic, service history, and clinical factors associated with readmission to state operated inpatient psychiatric hospitals by children and adolescents. Using computerized administrative data records for 3,969 consecutive index admissions of individuals between the ages of 7 and 17 inclusive, we examined hospital reentry among youth receiving services at these facilities. The univariate analysis comparing youths who reentered the hospital with those who did not reenter indicated that reentry was more likely to occur among African American youths and among those who were diagnosed with psychotic disorders. Reentry occurred less frequently among youths diagnosed with depressive disorders. Reentry also occurred less frequently among youths living in areas having an organized array of community-based mental health services. Youths who reentered the hospital were significantly older and had longer prior hospitalizations than those not reentering. The proportional hazards model used in the analysis indicated several factors associated with increased likelihood of hospital reentry. African American youths and individuals diagnosed with a psychotic disorder were more likely to reenter the hospital. Younger youths and those having lengthy prior hospitalizations were at increased risk for reentering the hospital. Youths living in urban, white, higher income communities were less likely to reenter the hospital.     

Clinical and Non-Clinical Characteristics Associated with Medication Use Among Children with Serious Emotional Disturbance

Our study explores the clinical and non-clinical characteristics associated with medication use among children with serious emotional disturbance who are referred into community-based family-driven system of care settings. Using data collected as part of the Comprehensive Community Mental Health Services for Children and Their Families Program initiative, our study provides results from analyses completed on 7,009 children and adolescents with serious emotional disturbance. Using both bivariate and multivariate statistical analyses, the researchers found that females entering systems of care were less likely to have received medication in the 6-months prior to entry, as were children of African-American and Native-American heritage compared to children from non-Hispanic White heritage. Children referred from mental health, child welfare or who were self-referred were more likely to use medications than those referred from juvenile justice. Children with histories of prior inpatient, outpatient, day treatment, or school-based services were between 2 and 4 times more likely to use medications than children without such histories. Children with family histories of mental illness and those who were Medicaid recipients were also more likely to use medications. Family income was also positively related to medication use and younger children were more likely to use medications than older children. Implications of the findings are discussed.     

School Mobility and Students with Emotional Disturbance

We examined the school mobility of a cross-sectional sample of 70 secondary-age youth with emotional disturbance (ED). Data were collected through an archival review of school records. Students’ school mobility histories were examined in terms of the overall number of schools attended in the elementary school years, as well as the timing of the moves that were made. Findings indicate that sample students experienced high rates of school mobility with 66% having changed schools at least once by the end of 2nd grade and 89% having changed schools at least once by the end of 5th grade. Strategies for minimizing school mobility and the impact of high rates of school mobility are reviewed.     

Serving Culturally Diverse Children with Serious Emotional Disturbance and Their Families

Over the coming decades, we can expect that cultural diversity will abound within the U.S. population and the imagery of an American melting pot will long be discarded. One significance of this trend will be the imperative to account for cultural diversity in assessing the needs of children with serious emotional disturbance (SED), to ensure that assessments, diagnoses, and treatments are accurate, fair, and meaningful. To achieve that end, however, will first require that all persons in the fields of education, mental health, social services, and juvenile justice become fully prepared to support children with SED and their families, prepared to bring to the process a sophisticated understanding of the interplay between culture and social behaviors. Nothing less than that level of preparedness will enable practitioners to develop unbiased interventions that competently and sensitively weigh cultural influences and target the needs of diverse students with emotional and behavioral difficulties. In this paper, we present the need for culturally competent practitioners in the area of SED, ways in which service providers can increase their cultural knowledge, and strategies for more effective service with this population.     

Parent Satisfaction with Case Managed Systems of Care for Children and Youth with Severe Emotional Disturbance

Case management has emerged as an integral component of current efforts to reform the delivery of mental health services to children and youth with Severe Emotional Disturbance (SED). We examined parental satisfaction with one program's case management system for SED children. In order to validly address parental satisfaction, the program first turned to a group of its parents to develop a satisfaction measure, the Family Satisfaction Survey (FSS). Of the 51 parents who returned an FSS, 74% of the parents were generally satisfied while 26% indicated that they were dissatisfied with their families' case management services. Multivariate regression analyses were employed to examine the role played by client, service, and outcome variables in predicting parental satisfaction. After controlling for child diagnoses, severity of impairment, and levels of psychosocial stress, parent satisfaction with case management services was best predicted by the frequency of monthly contact and fewer days is a psychiatric hospital proportional to length of service. Our results suggest that parent satisfaction is based not only on what case managers do but on how this service impacts SED children's ability to remain at home and in their communities.     

Predicting Resource Utilization by Children with Serious Emotional Disturbance and Their Families

Our study represents a rural case management agency's use of its data to aid in its transition from being funded by federal grant funds to self-sustainment. We wanted to learn if some characteristics of those children served could predict the resources needed to serve them. We analyzed data on 90 children and adolescents living in a rural community. Using multiple regression analysis we found that CAFAS total and CBCL total problem scores predicted Medicaid reimbursements but not flexible funds spending or case management hours. History of psychiatric hospitalization, however, predicted flexible funds spending and case management hours. Using one-way ANOVA and post hoc analysis we found that the staff members' assessments of each child and family's level of service needs were reflected in differences in mean CAFAS total scores, Medicaid reimbursements and case management hours, but not CBCL total problem scores or flexible funds spending.     

Integrating Systems of Care in California for Youth with Severe Emotional Disturbance IV: Educational Attendance and Achievement

Empirical results are presented from school-based interventions in three California counties that are pioneering participants in a carefully evaluated effort to create an innovative system of care for youth with severe emotional disturbance. Data are presented about the educational attendance and achievement of youth enrolled in clinical and academic programs designed to provide collaborative mental health and education services. Attendance levels were uniformly high. The youth were below expected grade level as measured by standardized tests at program admission. Across programs, two counties demonstrated grade level increases of one year or more for one year in school on all subscales of established measures of educational achievement. The third county demonstrated increases of slightly less than one year on two of three subscales of the educational achievement measures. These results are the first from a multisite demonstration of integrated education and mental health programs embedded within a broader system of care for youth. The findings, combined with those from our prior studies, illustrate that is possible to reduce and control placements in restrictive levels of care while improving the academic performance of a vast majority of the youth enrolled in specialized programs within the care systems.     

Strengthening the Capacity of Schools and Communities to Serve Students with Serious Emotional Disturbance

Target 2 of the National Agenda for Improving Results for Children and Youth with Serious Emotional Disturbance stipulates that communities and schools serve children and youth with emotional needs in their neighborhood homes and regular classrooms by developing the capacity of teachers, schools, and communities to provide supports and resources. This statement is partially based upon the idea that children and youth who are placed out-of-district for special needs and services are often alienated from their neighborhoods and their communities. The Westerly, RI, and Alliance, OH, school districts, service delivery agencies and families collaborated to implement system-wide change, so as to accomplish two main goals. First, they intended on retaining students with emotional needs in their neighborhood schools and in regular classrooms. Second, they aimed to increase their effectiveness in addressing the needs of all students by providing a range of integrated resources. Both communities were strongly driven by the underlying objective: to improve the educational, economic, and social outcomes for all children.     

The Prevalence of Serious Emotional Disturbance: A Re-Analysis of Community Studies

The goal of these analyses was to use existing data to provide an empirically-based estimate of the prevalence in the population of Serious Emotional Disturbance (SED) in children and adolescents, to assist States in their task, required under PL 102-321, of including such estimates in their applications for Block Grant funds. Seven data sets were identified that could provide estimates of SED. The principal investigators agreed on common definitions of the key components of SED: a psychiatric diagnosis and significant functional impairment. Two definitions of impairment were used: domain-specific (impairment in one or more of three areas of functioning) and global (in the worst 10% over all). They also defined a set of correlates and risk factors for SED: age, gender, race/ethnicity, and poverty. Investigators then reanalyzed their own data, using these standard definitions, and calculated the proportion of SED youth who received mental health care. The median estimate of SED with global impairment was 5.4%, with a range from 4.3% to 7.4%. Estimates of SED with domain-specific impairment ranged from 5.5% to 16.9% (median 7.7%). Rates were slightly higher in boys. There were no clear ethnic differences. Poverty doubled the risk of SED. Only one SED child in four had recently received mental health care. Estimates of SED are critically dependent on the method used to define diagnosis and functional impairment. Using common definitions, seven studies produced fairly consistent estimates, which were similar to the estimate of prevalence of Serious Mental Illness (SMI) in adults. Implications for the estimate of State-by-State prevalence rates are discussed.     

The Longitudinal Relationship Between Satisfaction with Transitional Care and Social and Emotional Quality of Life Among Chronically Ill Adolescents

This study aimed to identify the relationship between satisfaction with transitional care and quality of life of chronically ill adolescents over time. This longitudinal study included adolescents with type I diabetes, juvenile idiopathic arthritis (JIA), and neuromuscular disorders (NMD). At baseline 138 respondents (response rate 31 %) filled in a questionnaire and 188 about 1 year later (response rate 43 %). Analysis of variance showed that adolescents with diabetes reported the highest physical quality of life, followed in order by those with NMD and JIA (p?≤?0.01). Adolescents with diabetes reported the highest social quality of life, followed in order by those with JIA and NMD (both at p?≤?0.001). Univariate analyses showed that satisfaction with transitional care at T0 was significantly related to emotional and physical quality of life at T1 (both at p?≤?0.05). At T1, satisfaction with transitional care was significantly related to the emotional, physical, and social domains of quality of life (all at p?≤?0.001). Multiple regression analyses revealed that satisfaction with transitional care at T1 was related to emotional (β -0.20; p?≤?0.05) and social (β -0.35; p?≤?0.01) quality of life domains over time. This indicates that lower gap scores, which measured differences between ‘best care’ and ‘current care,’ are associated with better social and emotional quality of life in this sample of adolescents. Satisfaction with transitional care and social and emotional quality of life are related over time.     

Description and Formative Evaluation of the Kentucky IMPACT Program for Children with Serious Emotional Disturbance

The Kentucky IMPACT Program is described and formative evaluation results are reported. This information suggests that the Program has value for children and youth with serious emotional and behavioral disorders.     

Use of Out-of-Home Care Among a Statewide Population of Children and Youth Enrolled in Medicaid

System-wide research on the use of out-of-home care among children and youth is needed to inform the development of policies and services. We used Medicaid claims from North Carolina to examine patterns of out-of-home care, identify demographic and diagnostic differences between those who received care in residential treatment, psychiatric hospitals, or general hospitals, and determine whether demographic or diagnostic characteristics were associated with having more than one out-of-home stay during the year. Among those who received out-of-home care during a 1 year period, 36% received care in residential treatment only, 32.4% in general hospitals only, and 17.6% in psychiatric hospitals only, while 14.0% used more than one sector of out-of-home care. Boys, teenagers, and youth in foster care or diagnosed with emotional disturbance or hyperkinetic syndrome had higher odds of receiving care in residential treatment only whereas girls, youth age 19–21, and those with depressive and stress and adjustment disorders had higher odds of receiving care from hospitals only. Teenagers and youth in foster care had higher odds of having more than one stay. Among those with more than one stay, there were 300 patterns of care and nearly half received care from more than one service sector. The implications for services and policy are discussed. Further research is needed to understand patterns of out-of-home care and the factors that influence placement decisions.     

青春期情感自主性与学业成绩相关研究

本研究采用斯腾伯格和斯尔弗伯格编制的情感自主性量表 (EmotionalAutonomyScale)研究青春期情感自主性与学业成绩之间的关系。研究结果表明 :1.青春期表现出较为明显的情感自主性 ;2 .情感自主性对学业成绩的影响呈显著性水平 ;3.青春期情感自主性与学业成绩呈现相关关系。父母形象的非理想化与学业成绩成正相关 ,即父母的非理想化程度越高 ,学业成绩越差 ;而个体化与学业成绩成负相关 ,即个体化程度越高 ,学业成绩越差。 4 .青春期情感自主性存在明显的性别差异 ,女生的得分明显高于男生